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When a young woman came to the ED at Bellingham, WA-based St. Joseph’s Hospital with abdominal pain, she was asked about allergies. "She said she had some problems with latex in the dentist’s office," recalls Janice C. Taylor, RN, BSN, CEN, CFRN, the ED nurse who cared for the patient.
The patient was given a pelvic exam with the physician using latex gloves, and a vaginal ultrasound that used a latex condom over the probe. The following day, she returned to the ED with swelling in her perineal area and difficulty urinating. "I gave her a more comprehensive screening, and found that she had multiple risk factors for latex allergy," says Taylor. "For this exam, nitrile gloves were used."
The patient improved after taking antihistamines and was given specific instructions to tell all medical staff about her problem, says Taylor. "Since then, she has come in several other times," she says. "We used latex precautions and have not had any problems."
The above scenario underscores the need to identify patients with latex allergy, emphasizes Kristi K. Miller, RN, C, MS, president of Solutions for Healthcare, an Edina, MN-based consulting firm that provides education about latex allergy, and former project manager for Latex Initiatives at Allina Health System in Minneapolis. "Before we touch someone with a latex product, we need to know if there is a potential for an allergic reaction in that person," she says.
Here are ways to ensure that these patients are quickly identified:
• Educate patients about the importance of informing staff.
When a patient is first identified as latex-allergic, urge the patient to tell all medical personnel before any interventions are done, says Taylor. "The best way to identify latex allergic patients in the ED is to have them tell you," she stresses.
• Remove as many latex products as possible from the environment.
When a patient has been identified as latex-allergic, you should immediately remove latex gloves from the room and replace them with latex-free alternatives such as vinyl or nitrile, says Taylor. "Then place the box or cart of latex-free supplies at the bedside for easy use," she says. Apply allergy bands to the patient and place a sign at the bedside or the patient tracking board to alert all care givers that the patient is allergic to latex, says Taylor. For any procedure that might expose the patient to latex, like a vaginal ultrasound, ensure that nonlatex products are used, Taylor adds.
• Consider switching to all nonlatex equipment.
Do you ask patients about latex allergy first, then switch to nonlatex equipment as needed? If so, you may be putting patients at risk, warns Miller. Many EDs have decided to stop using a separate cart for latex-free supplies and switch to all nonlatex equipment, including IV tubing, blood pressure cuffs, catheters, and gloves of all kinds, so there is no chance of harming any patient, she reports. "This action parallels the idea of universal precautions for bloodborne pathogens,’" says Miller. "This is universal precautions to prevent latex allergy.’"
The cost of a latex-free examination glove is getting very close to its latex equivalent, she reports. "If your hospital decides on a particular brand and purchases in large volumes, the cost diminishes further," notes Miller. When switching to other types of latex-free products, the cost may be much less than you expect, says Miller. "I have seen it be almost a wash,’ because so many manufacturers have already changed their products to nonlatex and at no difference in cost," she says.
She points out that avoiding a double inventory for patients with latex allergies may reduce costs. This can amount to 20-50,000 products within a hospital, if you are stocking two brands chest tubes, IV tubing, and blood tubing, says Miller. "There is also a risk of using the wrong product with a person in an emergency if there is double inventory," she notes.
• Use a tool to ask patients about latex allergy.
Miller recommends using a screening form to determine if patients have a diagnosed latex allergy or if they have had reactions to latex in the past. (To see form, click here. Note: The form was developed by Allina Health System, Minneapolis. Use is limited to illustration purposes, and the tool should be individualized for a facility's own use.) "It also determines if they fall into a very high category of potential to develop a latex allergy," she adds. "This patient would benefit from us not using any latex products in their care."
• Consider the risks before using latex.
Think about the potential for an allergic reaction before you use a latex product "on or in" a patient, says Miller. The severity of a reaction depends on the individual’s level of sensitization from mild to severe, the route of exposure (cutaneous, mucous membrane, IV, peritoneal, or respiratory) and the amount of allergen load in the product, she explains. "All products are not equal," says Miller. "Dipped products like gloves, some catheters, and condoms have more allergen in them than molded products like blood pressure cuffs or bevels of syringes," she notes.
Any patient has the potential to develop symptoms with continued exposure, warns Miller. "In certain populations with chronic illness, we may be contributing to exposure over time so that the person may become clinically symptomatic down the road," she says. "This is another important factor for you to consider."
• Know risks of aerosolized latex.
If powdered latex gloves are used in the ED, aerosolized latex can stay airborne for hours, says Miller. "This may land on drapes, curtains, or clothing of the personnel," she adds. To avoid this, she recommends switching to nonlatex, nonpowdered examination gloves; low-allergen, nonpowdered sterile gloves; or all nonlatex gloves. "This prevents inadvertent exposure of a client with latex allergy that is being treated at the same time others are receiving care," she says.
Below is a partial listing of resources pertaining to latex-allergic patients:
• American College of Asthma, Allergy, and Immunology and American Academy of Allergy, Asthma, and Immunology. AAAAI and ACAAI Joint Statement Concerning the Use of Powdered and Non Powdered Natural Rubber Latex Gloves, Organizational Position Statement. Ann Allergy Asthma Immunol 1997; 79:487.
• Position Statement, American College of Allergy, Asthma, and Immunology. Latex allergy: An emerging health care problem. Ann Allergy Asthma Immunol 1995; 75:19-21.
• Kelly KJ, Walsh-Kelly CM. Latex allergy: A patient and health care system emergency. J Emerg Nurs 1998; 24:539-545.
• Kelly KJ. Natural rubber latex-induced anaphylaxis. American Academy of Allergy, Asthma, and Immunology conference paper presentation. New Orleans; March 20, 2001.
• Miller KK. Research-based prevention strategies: Management of latex allergy in the workplace. American Association of Occupational Health Nurses 2000; 48:278-290.
• Miller KK, Weed P. The latex allergy triage or admission tool: An algorithm to identify which patients would benefit from "latex-safe" precautions. J Emerg Nurs 1998; 24:145-152.
• U.S. Department of Labor, Occupational Safety and Health Administration. Technical Information Bulletin: Potential for Allergy to Natural Rubber Latex Gloves and other Natural Rubber Latex Products. Washington, DC:1999.
For more information about treating patients with latex allergy, contact:
• Kristi K. Miller, RN, C, MS, Solutions for Healthcare, 5153 Tifton Drive, Edina, MN 55439. Telephone: (612) 743-9970. Fax: (952) 944-1109. E-mail: firstname.lastname@example.org.
• Janice C. Taylor, RN, BSN, CEN, CFRN, St. Joseph Hospital, 2901 Squalicum Parkway, Bellingham, WA 98225. Telephone: (360) 734-5400. E-mail: JTaylor@peacehealth.org.